Surgical Overtreatment of Prostate Cancer May Be Decreasing

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Canadian study shows that nearly all men undergoing radical prostatectomy in Eastern Ontario in recent years have clinically significant prostate cancer.
Canadian study shows that nearly all men undergoing radical prostatectomy in Eastern Ontario in recent years have clinically significant prostate cancer.

In a study of patients who underwent radical prostatectomy for prostate cancer (PCa) in Eastern Ontario, Canada, investigators found that almost all patients in recent years have had clinically significant tumors, according to a new report.

The finding suggests that overtreatment of PCa with surgery is in decline, which increases the benefits and decreases the risks of PCa screening, the investigators concluded in a paper published in CMAJ Open (2018;6:E197-E201).

Luke Witherspoon, MD, MSc, of The Ottawa Hospital and University of Ottawa, and colleagues conducted a retrospective cohort study of 1897 men who underwent radical prostatectomy (RP) in Eastern Ontario from 2009 to 2015. The proportion of patients who had intermediate- or high-risk disease, based on National Comprehensive Cancer Network criteria, rose from 46.7% in 2009 to 90.2% in 2015. The proportion of men with clinically significant cancer at RP—which the authors defined as a Gleason score of 7 or greater or pathologic stage T3 or higher—increased by 5% per year during the study period.

Also during the study period, the proportion of tumors with a Gleason score of 7 or higher at RP increased from 55.9% to 92.7%, and the proportion of cancers with pathologic stage pT3 disease increased from 25.2% to 45.1%.

The authors noted that studies conducted in the United States and Europe also found an increasing proportion of men undergoing RP with intermediate- and high-risk disease in recent years. These studies, however, originated from single tertiary care academic centers, so the reported trends could be a result of referral bias or may only reflect the practice of academic centers, Dr Witherspoon and colleagues stated.

Reference

Witherspoon L, Lau JL, Breau RH, et al. Reducing overtreatment of prostate cancer by radical prostatectomy in Eastern Ontario: a population-based cohort study. CMAJ Open (2018;6:E197-E201.

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